Pradhan A, Saggu D, Bhandari M. Left bundle branch pacing cardiac resynchronization therapy vs biventricular pacing cardiac resynchronization therapy–time to write a requiem for biventricular pacing-cardiac resynchronization therapy. World J Cardiol 2025; 17(2): 103356 [DOI: 10.4330/wjc.v17.i2.103356]
Corresponding Author of This Article
Monika Bhandari, MD, Department of Cardiology, King George's Medical University, Shahmina Road, Chowk, Lucknow 226003, Uttar Pradesh, India. drmonikab@gmail.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Letter to the Editor
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. Feb 26, 2025; 17(2): 103356 Published online Feb 26, 2025. doi: 10.4330/wjc.v17.i2.103356
Left bundle branch pacing cardiac resynchronization therapy vs biventricular pacing cardiac resynchronization therapy–time to write a requiem for biventricular pacing-cardiac resynchronization therapy
Akshyaya Pradhan, Daljeet Saggu, Monika Bhandari
Akshyaya Pradhan, Monika Bhandari, Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
Daljeet Saggu, Department of Cardiac Electrophysiology, AIG Hospitals, Hyderabad 500034, Telangāna, India
Co-first authors: Akshyaya Pradhan and Daljeet Saggu.
Author contributions: Pradhan A conceived the idea and reviewed the manuscript; Pradhan A and Saggu D performed the revision; Pradhan A and Bhandari M submitted the revised version; Saggu D performed the journal search; Saggu D and Bhandari M prepared the first draft; Bhandari M performed the literature review; all of the authors read and approved the final version of the manuscript to be published.
Conflict-of-interest statement: There are none conflict of interest to declare.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Monika Bhandari, MD, Department of Cardiology, King George's Medical University, Shahmina Road, Chowk, Lucknow 226003, Uttar Pradesh, India. drmonikab@gmail.com
Received: November 18, 2024 Revised: January 24, 2025 Accepted: February 12, 2025 Published online: February 26, 2025 Processing time: 100 Days and 8.9 Hours
Abstract
Cardiac resynchronization therapy (CRT) reduces heart failure (HF) hospitalizations and all-cause mortality in patients with HF with reduced ejection fraction with left bundle branch (LBB) block. Biventricular pacing (BVP) is considered the gold standard for achieving CRT; however, approximately 30%–40% of patients do not respond to BVP-CRT. Recent studies have demonstrated that LBB pacing (LBBP) produces remarkable results in CRT. In this meta-analysis, LBBP-CRT showed better outcomes than conventional BVP-CRT, including greater QRS duration reduction and left ventricular ejection fraction improvement, along with consistently lower pacing thresholds on follow-up. Additionally, there was a greater reduction in New York Heart Association class and brain natriuretic peptide levels. This study contributes to the growing body of encouraging data on LBBP-CRT from recent years. With ongoing technological advancements and increasing operator expertise, the day may not be far when LBBP-CRT becomes the standard of care rather than the exception.
Core Tip: Cardiac resynchronization therapy (CRT) reduces heart failure (HF) hospitalization and all-cause mortality in patients of HF with reduced ejection fraction with left bundle branch (LBB) block (LBBB). However approximately 30%–40% of patients do not respond to Biventricular pacing (BVP)-CRT. Some recent studies have shown that LBB pacing (LBBP) provides an alternative for CRT. In the current study, Yasmin et al demonstrate that LBBP-CRT is better than conventional BVP-CRT in terms of QRS duration reduction as well as left ventricular ejection fraction improvement with consistent lower pacing thresholds on follow-up. The present study adds to a body of emerging encouraging data for LBBB-CRT in the past few years. With evolving technological modification and operator experience, the day might not be far when LBBB-CRT becomes the convention rather than exception.
